Contributors are listed in Appendix 1.
Clindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood—a prospective quasi-randomized controlled trial
Article first published online: 19 OCT 2011
© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases
Clinical Microbiology and Infection
Volume 18, Issue 6, pages 582–589, June 2012
How to Cite
Peltola, H., Pääkkönen, M., Kallio, P., Kallio, M. J. T. and The OM-SA Study Group (2012), Clindamycin vs. first-generation cephalosporins for acute osteoarticular infections of childhood—a prospective quasi-randomized controlled trial. Clinical Microbiology and Infection, 18: 582–589. doi: 10.1111/j.1469-0691.2011.03643.x
- Issue published online: 14 MAY 2012
- Article first published online: 19 OCT 2011
- Accepted manuscript online: 3 AUG 2011 12:37PM EST
- Original Submission: 14 April 2011; Revised Submission: 27 July 2011; Accepted: 27 July 2011 Editor: M. Paul; Article published online: 3 August 2011
- osteoarticular infections;
- septic/purulent arthritis
Clin Microbiol Infect 2012; 18: 582–589
No sufficiently powered trial has examined two antimicrobials in acute osteoarticular infections of childhood. We conducted a prospective, multicentre, quasi-randomized trial in Finland, comparing clindamycin with first-generation cephalosporins. The age of patients ranged between 3 months and 15 years, and all cases were culture-positive. We assigned antibiotic treatment intravenously for the first 2–4 days, and continued oral treatment with clindamycin 40 mg/kg/24 h or first-generation cephalosporin 150 mg/kg/24 h in four doses. Surgery was kept to a minimum. Subsiding symptoms and signs and normalization of C-reactive protein (CRP) level were preconditions for the discontinuation of antimicrobials. The main outcome was full recovery without further antimicrobials because of an osteoarticular indication during 12 months after therapy. The intention-to-treat analysis comprised 252 children, 169 of whom were analysed per-protocol: 82 cases of osteomyelitis, 80 of septic arthritis, and seven of osteomyelitis–arthritis. Staphylococcus aureus strains (all methicillin-sensitive) caused 84% of the cases. Except for one non-serious sequela during convalescence in both groups, and two late infections caused by dissimilar agents in one child, all patients recovered. The entire courses (medians) of clindamycin and cephalosporin lasted for 23 and 24 days, respectively. CRP normalized in both groups in 9 days. The patients were discharged, on average, on day 10. Loose stools were reported less often (1%) in the clindamycin group than in the cephalosporin group (7%), but two clindamycin recipients developed rash. Clindamycin or a first-generation cephalosporin, administered mostly orally, perform equally well in childhood osteoarticular infections, provided that high doses and administration four times daily are used. As most methicillin-resistant staphylococci remain clindamycin-sensitive, clindamycin remains an option instead of costly alternatives.